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CFPC exam KM > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Where is McBurney’s point

A

1/3 from anterior superior iliac spine to umbilicus

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2
Q

What is Rovsing’s sign

A

Palpation of left abdomen causes pain at McBurney’s point
Can be a sign on inferior appendix

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3
Q

What is psoas sign

A

Pain on flexion of hip against resistance or passive hyperextension of hip
Can be a sign of retrocecal appendix

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4
Q

What is obturator sign

A

Flexion then external or internal rotation of right hip hip causes pain
Can be a sign of a pelvic appendix

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5
Q

Investigations for appendicitis

A

Increased WBC
R/o pregnancy
AXR - free air if peroratoed, loss of psoas shadow
US - rule out gyne causes, may be able to visualise appendix
CT - thick wall, appemdocloth, only done after us considered

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6
Q

Management of appendicitis

A

IVF
Surgery
Abx - ampicillin, gentamicin and metronidazole

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7
Q

What is the definition of cholecystitis

A

inflamed gallbladder 2ndary to impacted gallstone

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8
Q

What is the definition of choledocholithiasis

A

gallstone in common bile duct

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9
Q

What is the definition of cholangitis

A

Obstructed of common bile duct causing biliary sepsis

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10
Q

What is charcot’s triad

A

fever, RUQ pain and jaundice

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11
Q

What is Reynold’s pentad

A

fever, RUQ pain, jaundice, shock, confusion

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12
Q

Investigations for cholecystitis/cholangitis

A

Increases WCC
Increased bili, ALT, ASST, *ALP
Blood cultures
R/o pancreatitis
Ultasound

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13
Q

Management of cholecystitis/cholangitis

A

NPO, IVF
NG if ileum
Analgesia
Abx - ampicillin + gentamicin/cipro + met
cholecystitis - surgery
cholangitis - ERCP + sphincterotomy, consider laparotomy

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14
Q

Signs of symptoms of diverticulitis

A

Fever
LLQ pain
Alternating constipation and diarrhea
Urinary symptoms
Nausea/vomiting
S+S fistula
Fever

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15
Q

Investigations for diverticulitis

A

Leukocytosis, increased Cr
Urinalysis, CRP
AXR - free air
**CT

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16
Q

Management for diverticulitis

A

Outpatient/uncomplicated:
Bowel rest/ clear liquid diet x 2-3 days
High fibre diet
Cipro and falgyl or amoxicillin/clav if indicated

Complicated:
NPO, IVF, NG
Cipro and flagyl
Percutaneous drainage if abscess
C scope after 6-8 weeks

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17
Q

When to consider surgery in diverticulitis

A

Unstable with peritonitis
Abscess >/ 4 cm / fistula / ruptured abscess
Complex

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18
Q

Causes of pancreatitis

A

Gallstones
Ethanol
Tumours

Scorpion sting
Mmicrobiology - TB, mumps reubella, HIV, CMV
Autoimmune
Surgery/trauma
Hyperlipidemia
Emboli/ischaemia
Drugs (furosemidem estrogen, H2 blockers, valproate, abx, ASA)

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19
Q

Signs and symptoms of pancreatitis

A

Pain, epigastric, radiates to pain, decreased leaning forward
N and V
Jaundice
Hypotension / tachycardia
Cullens and grey turners sign

20
Q

Investigations for pancreatitis

A

High WBC
High amylase
High lipase - preferred test
High ALT
AXR - colon cut off sign
Ultrasound - preferred test
CT

21
Q

Management of pancreatitis

A

IVF
NPO, NG
Analgesia
Drain abscess
Surgery if necrotic

22
Q

What is Ranson’s criteria

A

Prognosis for pancreatitis

At admission:
Glucose >11
Age >55
LDH >350
AST >250
WBC >16

During 48h:
Ca <2
HCG decreased more than 10%
aPO2 <60
Base >4
Urea increase > 1.8

23
Q

What gene is celiac related to

A

HLA-DQ2/DQ8

24
Q

What are the patterns of celiac disease

A

Classic: malabsorption symptoms
Non-classic: intestinal and extraintestinal symptoms
Subclinical: no symptoms, diagnosed from screening
Potential: abnormal antibiotics but normal histology

25
What conditions are associated with celiac disease
T1DM Autoimmune thyroditis and liver disease Down syndrome Turner syndrome IgA deficienc
26
What rash is typically seen in celiac
dermatitis herpetiform
27
What deficiencies are commonly seen in celiac disease
Vitamin B12 deficiency Iron deficiency Can have low calcium and vitamin D
28
What investigations are done to investigate for celiac disease
** Anti-TTG IgA Must have equivalent of 3 slices of wheat bread a day for 1-3 months prior to testing Serum IgA - if deficient order Anti-DGP
29
What monitoring should be done for celiac disease?
Annual anti-TTG Q2Year TSH Q1Year if previously normal ALT and AST
30
What cancer is associated with celiac
High risk T-cell lymphoma
30
What are the dermatological extraintestinal manifestations of crohn's
Erythema nodosum Pyoderma gangrenous Perianal skin tags Oral mucosal lesions Psoriasis Pallor
31
What are the rheumatological extraintestinal manifestations of crohn's
Inflammatory arthropathy AnkSpon Sacroilitis
32
What are the occular extraintestinal manifestations of crohn's
Uveitis Episcleritis
33
What are the hepatobiliary extraintestinal manifestations of crohn's
Primary sclerosing chalngitis Fatty liver
34
What are the urological extraintestinal manifestations of crohn's
Stones Fistula
35
What is the sequelae of malabsoprtion in Crohn's?
Anemia Cholelithiasis Nephrolithiasis Metabolic bome disease
36
What are the immune mediated diseases associated with Crohn's
Asthma Chronic bronchitis Pericarditis Psoriasis Celiac RA MS
37
What medications are used for an acute flare of Crohn's
Prednisone
38
What medications are used in Crohn's
Thiopuriness Methotrexate Biologics
39
What are the risks of long term PPI use
Hip fracture C Diff Pneumonia Low vitamin b12, mag, iron Hypoparathyroid
40
What are the Rome IV criteria
Recurrent abdo pain on ave atleast 1 day a week for the past 3 months with 2 of the following: Related to defecation Associated with a change in freq of stool Assocaited with a change in appearance of stool
41
What is the treatment for H. Pylori
First line: Amoxicillin 1000mg BID + Clarithromycin 500mg BID + Metronidazole 500mg BID and PPI for 14 days If penicillin allergic: Bismuth + tetracycline + metronidazole + PPI
42
What is always involved in UC
the rectum
43
What is the montreal classification of UC
Proctitis - within 18cm of anal verge distal to rectosigmoid junction Left sided colitis - extending from sigmoid to splenic flexure Right sided colitis - beyond the splenic flexure
44
What are the treatments for UC
5ASA MMX Biologics
45
Crohns vs UC

CFPC exam KM (16 decks)

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